VA Suicide Prevention ProgramAssociation of Military Surgeons of the United States (AMSUS) Annual Meeting Presentations

November 29, 2018

DisclosuresPresenter has no interest to disclose.

AMSUS and ACE/PESG staff have no interest to disclose.

This continuing education activity is managed and accredited by Affinity CE/Professional Education Services Group (ACE/PESG) in cooperation with AMSUS. ACE/PESG, AMSUS, planning committee members and all accrediting organizations do not support or endorse any product or service mentioned in this activity.

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Learning ObjectivesAt the conclusion of this activity, the participant will be able to:

1. Explain the most recent data surrounding suicide in the United States and suicide risk in the Veteran population.

2. Describe VA’s public health approach to suicide prevention and the important role communities play in preventing Veteran suicide.

3. Summarize the objectives, purpose, and recent updates regarding Executive Order 13822.

4. Explain VA’s suicide prevention resources and how they can be used to support Veterans.

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CE/CME Credit

If you would like to receive continuing education credit for this activity, please visit:

http://amsus.cds.pesgce.com

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Agenda• Suicide in the United States

• The Public Health Approach

• Putting Strategy Into Action

• Executive Order 13822

• VA Suicide Prevention Resources

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Suicide in the United States

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Issue Overview:

Suicide• National Public Health Problem (cdc.org)

• 10th-leading cause of death (~twice as many suicides as homicides)

• ~45,000 deaths per year (up almost 30% since 1999)

• Costs $69 billion annually

• Veteran and Service member issue

• Veteran Populations at risk• Younger Veterans

• Women Veterans

• In a period of transition

• With exposure to suicide

• With access to lethal means

• Other than Honorable Discharges (“Bad Paper”)

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VA Suicide Data Report: September 2018 Release• National Suicide Data Report

• Reports on trends in Veteran Suicide Deaths from 2005 – 2016

• Focuses on suicide counts and rates among various populations

• State Data Sheets

• Examined state level Veteran suicide deaths and compared to national and regional trends

• Available for all 50 states, D.C., and Puerto Rico

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Access the reports online:https://go.usa.gov/xnMDE

Important Figures

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Veteran Population

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Veteran Population

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Veteran Suicide Deaths: Count vs. Rate

Older Veteran population accounts for the bulk of suicide deaths due to

population size.

Younger Veteran population includes more recently transitioned Veterans

and has a higher rate of suicide.

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Veteran Suicide Deaths in 2016

Data Should Drive Efforts to Prevent Suicide

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58.1%of Veteran suicides were among

Veterans age 55 and older

69.4%of Veteran suicides resulted

from a firearm injury

The Veteran Suicide Rate and Count Increased from 2005 to 2016

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Veterans Recently Using VHA Services Had Higher Rates of Suicide than Veterans Who Did Not Use VHA Care

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VHA and Non-VHA Veteran Suicide Rates, 2005–2016

Veteran Suicide Rates by Age Group, 2005–2016

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Rates of Suicide Have Increased Substantially Among Younger Veterans

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Non-Federally Activated Former National Guard or Reserve Suicide Deaths, 2005-2016

Suicides increased for both former Guard and Reserve from 2005-2016.

0

100

200

300

400

500

600

700

2005 2007 2009 2011 2013 2015

Suic

ide

Co

un

ts

Year

National Guard Reserve

Veteran and Non-Veteran Deaths by Suicide, 2005-2016

0

5

10

15

20

25

30

35

40

45

Total Male Female

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16

Su

icid

e R

ate

per

10

0,0

00

Veteran Non-Veteran

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Death by suicide is more frequent among Veterans as compared to non-Veterans.

Veteran and Non-Veteran Adults Unadjusted and Age-and Gender-Adjusted Suicide Rates, 2005-2016

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• Suicide rates for Veteran and non-Veteran adults increased from 2005-2016.• In 2016, the suicide rate was 1.5 times greater for Veterans than for non-

Veteran adults, after adjusting for age and gender.

Risk• Prior suicide attempt

• Mental health issues

• Substance abuse

• Access to lethal means

• Sense of burdensomeness

• Recent loss

• Legal or financial challenges

• Relationship issues

Protective• Access to mental health care

• Sense of connectedness

• Problem-solving skills

• Sense of spirituality

• Mission or purpose

• Physical health

• Social and emotional well-being

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Risk and Protective Factors

Goal: Minimize risk factors and boost protective factors

50% of Veterans Do Not Use VA Benefits or Healthcare

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Veterans whouse at least one VA benefit or healthcare service.

Of this group, about 6 million Veterans use VA health care (about 30 percent of all Veterans).

Veterans whodo not useVA benefits or healthcare.

9.7million10.2

million

The Public Health Approach

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VA Suicide Prevention Strategy

Public Health Approach to Suicide Prevention• The public health approach

seeks to answer the foundational questions:

• Where does the problem begin?

• How could we prevent it from occurring in the first place?

• To answer these questions, public health uses a systematic, scientific method for understanding and preventing violence.

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Suicide Prevention is Everyone’s Business

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National Academy of Medicine (NAM) Classification

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Prevention Levels and Example Efforts

Universal • Critical partnerships

established

• National Sports Shooting Foundation (NSSF) partnership

• Johnson & Johnson PSA

• #BeThere campaign

Selective• Mental Health hiring initiative

• Lethal means safety training

• Mental health care for Other Than Honorable discharged Veterans

• Executive Order to expand Veteran eligibility for mental health care

• DoD/VA transition MOA

• SAMSHA Mayor’s Challenge

• Telemental health

• Treatment engagement

• Open innovation safe gun storage challenge

• VCL info printed on VA canteen receipts

Indicated• REACH VET

• Discharge planning and follow-up enhancements

• Expansion of Veterans Crisis Line (VCL)

• VCL services

• S.A.V.E. training

• Postvention: follow-up care for family members and friends of someone who has died by suicide

Public Health Approach to Suicide Prevention

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Putting Strategy Into Action

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VA Suicide Prevention Strategy

National Strategy for Preventing Veteran SuicideGoal: Provide a framework for identifying priorities, organizing efforts, and contributing to a national focus on Veteran suicide prevention over the next decade.

• Aligns with the 2012 National Strategy for Suicide Prevention.

• Consists of 4 strategic directions, 14 goals, and 43 objectives.

• Leverages the public health approach to suicide prevention.

• Focuses on the importance of collaboration and urgency.

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Download a copy at:Mentalhealth.va.gov/suicide_prevention

Leveraging the Public Health Approach

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Our Implementation Model

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Implementing Strategic DirectionsHealthy and Empowered Veterans, Families, and CommunitiesWork with community partners and policymakers to promote resources for Veterans and to promote mental health awareness and treatment.

Clinical and Community Preventive ServicesShare resources, training opportunities, interventions, and lethal means safety resources with providers outside VA and with clergy, first responders, law enforcement officials, and community partners.

Treatment, Recovery, and Support Services Work with local emergency departments and hospitals to promote Veteran suicide prevention resources and to ensure continuity of care for all Veterans admitted to an inpatient mental health unit.

Surveillance, Research, and EvaluationShare the VA National Suicide Data Report and National Strategy for Preventing Veteran Suicide with community partners.

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A Call to Action

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Executive Order: Supporting Our Veterans During Their Transition from Uniformed Service to Civilian Life

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Executive Order and Joint Action Plan• Executive Order 13822: “Supporting Our Veterans During Their

Transition From Uniformed Service to Civilian Life”• Instructs VA, DoD, and DHS to work together to ensure newly separated

Veterans receive one year of mental health care from VA after discharge.

• The goal is to support new Veterans in making a successful transition to a fulfilling civilian life and to have access to any needed mental health care during the critical first year period following separation from active duty.

• Joint Action Plan Goals:• Ensure ALL transitioning Service members are aware of and have access to

mental health services.

• Ensure the needs of at-risk Veterans are identified and met.

• Improve mental health and suicide prevention services for individuals that have been identified (indicated populations) in need of care.

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Risk and Protective Factors during Transition Time• Belongingness

• Thwarted belongingness was the risk factor communicated most by suicide decedents in a study of death investigation files for active duty U.S. Air Force (USAF) members.

• Social Support• In a study of active duty Air Force Security Forces personnel, esteem

support (feeling respected, encouraged, and valued) was associated with significantly less severe suicidal ideation.

• Unit Cohesion• In a study of redeployed Army soldiers, unit cohesion was a significant

protective factor. Soldiers with greater combat exposure but higher levels of unit cohesion had relatively lower levels of suicide-related ideation.

• In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide-related ideation.

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• Outreach• Early and Consistent Contact (1.1), Messaging Campaign (1.4), Warm Hand-

offs for Peer Support (2.1), Peer Support Outreach (2.5), Peer Specialist Community Outreach Pilot (Clay Hunt; 2.6), Expand Military OneSource (3.3)

• Transition• Pre-transition VA Health Care Registration (1.2), Modification of Transition

Assistance Program (TAP; 1.3), Increased VSO Engagement Pre-Transition (1.5), Readiness Standards (2.3)

• Monitoring• Screening and Identification (2.2), Predictive Analytics (2.7), Improved

Monitoring (3.2)

• Access• Whole Health Peer Groups (2.4), Easy Button (3.1), Build and Expand

Partnership Models (3.4)

Buckets of Effort

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VA Suicide Prevention Resources

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Free, Confidential Support 24/7/365

• Veterans

• Service members

• Family members

• Friends

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Veterans and Military Crisis Line

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S.A.V.E Training

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Available online for free: psycharmor.org/courses/s-a-v-e/

• Suicide prevention training video that’s available to everyone, 24/7

• Less than 25 minutes long

• Offered in collaboration with the PsychArmor Institute

Suicide Risk Management Consultation Program

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Public Health Video

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Questions?

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Thank you.

Stay Connected

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Follow us on social media!

U.S. Department of Veterans Affairs

Veterans Health Administration

Make the Connection

@deptvetaffairs

@veteransmtc

@deptvetaffairs

@veteranshealth

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Back-Up Slides

Make the ConnectionOnline resource featuring hundreds of Veterans telling their stories about overcoming mental health challenges.

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https://maketheconnection.net/conditions/suicide

Coaching into CareProgram for families and loved ones of Veterans, helping them encourage the Veteran in their lives to seek support.

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#BeThere Prevention Initiative

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https://www.youtube.com/watch?time_continue=60&v=MCSZ7FjTq5I

We All Have a Role to Play

bethereforveterans.com

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#BeThere for Veterans PSA: